OCD – Obsessive Compulsive Disorder (Video)
What is Obsessive-Compulsive Disorder (OCD)?
Obsessional compulsive state
The word ‘obsessional’ is overused. In psychiatry it can be applied in three clear settings:
• An obsessional compulsive neurosis. This is an illness in its own right;
• An obsessional symptom. This can occur in many mental illnesses, e.g. anxiety states and eating disorders. People with anorexia nervosa may feel the need to know the exact calorific content of each food they are eating or cut up their food in a particular way.
• An obsessional personality type This is a way of describing people of particular personality who may then go on to develop an obsessional compulsive neurosis. To have some features of obessionalism in your character can be very useful. Obsessional people tend to be careful, do not take undue risks, check what they are doing and set themselves high standards. The negative side of this personality profile is that it means you may be less flexible, and deal less well with change – there is a need to feel in control.
Obsessions are recurring and persistent ideas, images or impulses that the person experiencing them knows are irrational and sometimes absurd. They are fully aware that the thoughts come from their own mind. They attempt to resist the thoughts and it causes suffering. The thoughts can recur hundreds of times a day.
Compulsions are the actions that a person with obsessive compulsive disorder (OCD) feel that they must, reluctantly, perform, for example washing hands for fifteen minutes after using the lavatory. There is a compulsion plus a desire to resist it (which causes mounting agitation and unpleasant tension). There is a big overlap between OCD, depression and anxiety. Very often elements of all three illnesses are seen in OCD.
I have been told that I have OCD. What causes it?
We believe that OCD is caused by abnormalities in the dopamine system of the brain. This chemical abnormality can be seen using special PET (positron emission tomography) scans.
Can it be treated?
OCD is successfully treated with behaviour and drug therapies. As you improve, not only do you function much better but, if a PET scan is repeated, it reverses. This is an exciting finding and one of the very few illnesses in psychiatry where we can ‘track’ the chemical imbalance. In the future, we may well be able to do the same with other psychiatric illnesses.
Behaviour therapy is very helpful. Several approaches are taken:
• Response prevention is a behaviour therapy technique in which you are gently prevented from performing rituals.
The therapist might also help ‘model’ new responses – perhaps dirtying hands and waiting a long time before washing them again. The sufferer is encouraged to do likewise.
• Recurring thoughts can be more difficult to treat than the actions. Thought stopping, however, can be very helpful. You need a loose-fitting elastic band on your wrist. When the unwanted thought occurs, you say ‘Stop’ and ‘ping’ the band. This stings your skin a little, and stops your thoughts. You then try breathing more smoothly and deeply; meanwhile you can either ‘ground’ yourself in the here and now, and look, listen and become very aware of your surroundings – the colours in the room, the feel of the chair you are sitting on, and so on. This technique pulls you back from going over and over your thought and you replace it with an awareness of your surroundings. The thought will recur – you then need to repeat the process. If you prefer, instead of really being in the present, you can imagine (in detail) the scene on your favourite beach. You can become very skilled at this with practice. A yoga teacher can help teach this method.
• Cognitive behaviour therapy is much less effective in OCD than behaviour therapy.
What drugs will I be given?
Clomipramine is a long-established tricyclic antidepressant that is useful in OCD. The dose can be slowly and steadily increased as necessary. It has calming, anti-obsessional effects. The newer SSRIs like fluoxetine (Prozac), citalopram (Cipramil) and paroxetine (Seroxat) all have anti-obsessional effects. None of the group has been found to be more effective than another, but you may find that you can tolerate one particular drug better. The dose of drug used to treat OCD tends to be higher than the dose used in depression. The antiobsessional effect may not clear for up to 7 or 8 weeks. It is worth trying to be patient. Before the anti-obsessional effect is seen, some of the unpleasant tension, anxiety and low mood, which so often accompany OCD, may well show a good improvement.
Drug treatment and behaviour therapy are equally effective. There is, as yet, no research evidence to say that combining drug therapy with behaviour therapy is better still, but clinical experience suggests that it may be.
